AccountId: 011433970860
ContactId: 2c962bfd-9b7e-48d8-b308-76edccbbf7fc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 904260 ms
Total Talk Time (AGENT): 452235 ms
Total Talk Time (CUSTOMER): 312741 ms
Interruptions: 5
Overall Sentiment: AGENT=0.5, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/20/2c962bfd-9b7e-48d8-b308-76edccbbf7fc_20250620T19:58_UTC.wav
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[CUSTOMER][NEUTRAL] I do.
[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I had a question. I have the, uh, uh, the MIC from your insurance, but I'm looking for the doctor in the network. Uh, how can I find it? We do we have any website or that I can look up and find a doctor in the network?
[AGENT][NEUTRAL] OK, so you're trying to find out how to go about locating a network provider in your area, is that correct?
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] Yes, ma'am. Well, I can try and direct you where to locate that information, but first off I'll need to pull up your policy and verify some things with you for security and see what type of coverage you have with us, OK? So who am I speaking with, please?
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] But when, uh, [PII] that's my uh under my husband name when [PII].
[CUSTOMER][NEUTRAL] It's your name.
[AGENT][NEUTRAL] OK, but
[AGENT][NEUTRAL] OK, so your name is [PII], is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and [PII], what is your
[CUSTOMER][NEUTRAL] Differ event about different.
[CUSTOMER][NEUTRAL] Uh, I think you can look up by my husband name [PII]
[AGENT][NEUTRAL] OK, first off, yes, ma'am. No, ma'am. OK, one moment. First off, what is your phone number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And what is the policy number?
[CUSTOMER][NEUTRAL] Policy number, um.
[CUSTOMER][NEUTRAL] 02559169
[AGENT][NEUTRAL] say that for me one more time, please.
[CUSTOMER][NEUTRAL] 02559169
[AGENT][NEUTRAL] Thank you, so one moment while I get the policy information pulled up.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so first off, as I stated, I would have to verify several things with you for security. So if you could first please verify your husband's name again and his date of birth and then your full name and your date of birth.
[CUSTOMER][NEUTRAL] OK, [PII]
[CUSTOMER][NEUTRAL] Last name [PII]
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And his date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And then your full name and date of birth?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] And last name [PII]
[AGENT][NEUTRAL] OK. And your date of birth, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you and your home mailing address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And the phone number that we have on file is actually the same phone number that you gave me. So that is your phone number. Is that correct, [PII]?
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] OK, thank you. And then the last piece of the well actually that'll be all that I need to verify with you. So on this policy that you all have with APL, this is not a network plan, so you can, there's not a specific network involved with this, which means you can choose any provider to go to.
[CUSTOMER][NEUTRAL] Oh, because when they choose my own, uh, uh, my own doctor, they say that uh I'm not in the, the network, so how can
[AGENT][NEGATIVE] OK, well, I'm not, I guess I don't know why they, this is not a network plan.
[CUSTOMER][NEUTRAL] And that's already pay me.
[AGENT][NEUTRAL] So it would, it's not an in or out of network.
[AGENT][NEUTRAL] With this.
[AGENT][NEUTRAL] This limited benefit plan that you all have is a non-network plan, which means you may select any doctor to go to.
[CUSTOMER][NEUTRAL] And uh I can go any doctor to go to.
[AGENT][POSITIVE] Correct, yes ma'am.
[CUSTOMER][NEUTRAL] And then how can they, how can the insurance pay for me?
[AGENT][NEUTRAL] So if your provider will not file the claim for you, you may submit your own claims to APL.
[CUSTOMER][NEUTRAL] Oh, OK, so I have to pay uh the doctor and then uh get the, the file to the APL to get the credit back. That's what you mean.
[AGENT][NEUTRAL] That, yes, ma'am. If they, if your doctor does not file, will or will not file your insurance for you, then yes, ma'am. You can file your own claim.
[CUSTOMER][NEUTRAL] OK, because when I talk to my uh family doctor, he said that oh I'm not in the network, so I don't take the insurance, so you have to pay the, you know, the job, the job, and then uh.
[CUSTOMER][NEUTRAL] And then if I had to pay the, the charge and then I will, uh, like I will claim by myself to the APL.
[AGENT][NEUTRAL] OK, so if you are gonna have to file your own claim, Ms. [PII], you can actually get your claim form that has all of the instructions on it. If you go to our public website.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] At [PII].
[CUSTOMER][NEUTRAL] Oh,
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And when you go to our website, there is a tab at the top that says claims and forms.
[AGENT][NEUTRAL] And you would just click on that link.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then scroll down the page, the web page, and you're gonna see a box that says filter by product.
[AGENT][NEUTRAL] That has a green arrow in it, a drop down arrow, and if you will click on that drop down arrow, it gives you a list of products.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And this plan is the hospital indemnity plan.
[AGENT][NEUTRAL] So you would just click on the word hospital indemnity.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then you
[CUSTOMER][NEUTRAL] Can I do it w[PII] I'm not?
[AGENT][NEUTRAL] I'm sorry.
[CUSTOMER][NEUTRAL] I got because I opened the the account already. Can I, when I log in, will my account secure uh [PII]?
[CUSTOMER][NEUTRAL] Can I do it when I log into my account?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Now, Miss um Miss [PII].
[AGENT][NEUTRAL] If Mr. [PII] gave you permission to set up the profile, um, then you can do that. However, he is going to the portal has changed so a new profile will have to be created, you will not be able to log in like you did before.
[AGENT][NEUTRAL] But I can only provide the information on how to set up that profile with him unless he authorizes me verbally.
[AGENT][NEUTRAL] To do that with you because he is the primary policy holder.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK, so, uh, only he can set up the uh log in account.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] Yes, now a new account will have to be set up before you can log in again, mhm, because there was an update done to that portal.
[CUSTOMER][NEUTRAL] And then
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But once you, so you have to get your claim form like I was explaining first.
[AGENT][NEUTRAL] Because the instructions for the documents that you will also need to provide to us when submitting a claim is on that claim form.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, on the phone. So, uh, can I, when I check this.
[AGENT][NEUTRAL] Mhm. On the claim form it has instructions.
[CUSTOMER][NEUTRAL] OK, on the claim form, do they, they check that uh about how much they will cover for the, uh, certain service like uh annual checkup or emergency or whatever, do they show up on the claim form that how much maximum they can pay? Do they have on the information?
[AGENT][NEUTRAL] No, ma'am, that information, that information is in the, in the portal under the policy information, and we would have to receive the claim to review before we would be able to determine what benefits would be payable.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Ah.
[AGENT][NEUTRAL] And any information that I do provide for you, [PII], about benefits would be a verification of benefits and not a guarantee of payment.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] A.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh, OK. So, uh, like last time I called, the, the lady say that master move they can pay for the like, um, uh, reimburse for the annual checkup, like a 200 something, right?
[AGENT][NEUTRAL] I would have to pull up your policy information for that. Um, I'm not, give me just a moment and I can pull that up.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK. Now, let's give me just a moment.
[AGENT][NEUTRAL] So under this specific plan that you all have, there are not any benefits on here, [PII] for wellness visits. This is only related to sickness. If you are sick and have to go to the doctor, but there's, but, yes, there's not wellness benefits.
[CUSTOMER][NEUTRAL] Oh, OK, so not the checkup when I say, uh, so not for the checkup, just for the sickness when I get the emergency something like that.
[AGENT][NEUTRAL] On this.
[AGENT][NEUTRAL] Correct. Correct. So, for example, if you were sick and had to go to the physician's office on this limited benefit plan, the benefit for an office physician's office visit due to outpatient excuse me, accidents.
[CUSTOMER][NEUTRAL] OK uh.
[AGENT][NEUTRAL] For an accident is.
[AGENT][NEUTRAL] Excuse me.
[AGENT][NEUTRAL] Give me 1 2nd.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so this is related to an accident. These benefits would be related to an accident on this particular plan that you all have.
[CUSTOMER][NEGATIVE] Oh, for the accident and sickness, not for the wellness.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] this policy is actually for accident and it doesn't for an office visit, that is for accident-related.
[CUSTOMER][NEUTRAL] Ah,
[CUSTOMER][NEUTRAL] Oh, OK, OK. So anything happen, I go to the, uh, urgent care, uh, they will cover like uh anything that happened me to the emergency, like go to the ER or agent care, they will cover it.
[AGENT][NEUTRAL] Not for sickness.
[AGENT][NEUTRAL] An urgent care visit is something that we could could review for if it's related again to some type of accident.
[CUSTOMER][NEUTRAL] Oh, OK, OK.
[AGENT][NEUTRAL] Mhm. Yes, ma'am. This is for accident. It would be for urgent care and office visits.
[AGENT][NEUTRAL] If you were, yes, if you were admitted now, you know, same thing, um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] You do have benefits.
[CUSTOMER][NEGATIVE] So but that's my very, the plan is very limited, so we don't have, we have nothing, no one.
[AGENT][NEUTRAL] It is.
[AGENT][NEUTRAL] This is a, right, this is not major medical insurance, [PII]. This is a limited benefit plan. It's called a Hospital indemnity limited benefit plan.
[CUSTOMER][NEUTRAL] 00, OK.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] Yes, ma'am. So for things for an emergency room, urgent care, physician's office, those are related to accident. Those benefits are related to accident treatment.
[CUSTOMER][NEUTRAL] Ah.
[CUSTOMER][NEUTRAL] Oh, OK. So not wellness visit, uh, anything like, uh, how about a mammogram no mammogram.
[AGENT][NEUTRAL] No, ma'am.
[AGENT][NEUTRAL] No, ma'am.
[AGENT][NEUTRAL] No.
[AGENT][NEGATIVE] No, that would not be covered.
[CUSTOMER][NEUTRAL] Uh, nothing, just for the accident.
[AGENT][POSITIVE] Correct, under this coverage. Yes, ma'am.
[CUSTOMER][NEUTRAL] Uh, they're not covered, OK.
[CUSTOMER][NEUTRAL] All that the covers, OK. And uh, oh, OK, that's it. I know. OK, thank you.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][POSITIVE] Well, you're very welcome.
[CUSTOMER][NEUTRAL] Can I [PII]ge the seat?
[AGENT][NEUTRAL] Ma'am.
[CUSTOMER][NEUTRAL] I had a question. Uh, and if everything happen, can I change the policy?
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEGATIVE] I have to wait for the renewal.
[AGENT][NEUTRAL] No, ma'am, that would be a question that your husband would have to speak to his HR department about.
[CUSTOMER][NEUTRAL] Oh, it's called HR.
[AGENT][NEUTRAL] His HR department. Uh-huh. Yes, ma'am.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][POSITIVE] OK, all right, thank you so much.
[AGENT][POSITIVE] Oh, well, you're very welcome. So is there anything else that I can try and help you with today?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] No, I just want to know that I have to get in my uh routine checkup, but I can't, I have to pay my own.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I could look looking for my uh doctor that do they, how much they charge if I pay in the pocket.
[CUSTOMER][NEUTRAL] That's all.
[AGENT][NEUTRAL] Oh OK.
[CUSTOMER][POSITIVE] All right, thank you so much. OK, bye bye.
[AGENT][POSITIVE] Well, you're very welcome. Yes, ma'am. And thank you again for calling APL. I hope you have a nice weekend.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][POSITIVE] Yes, ma'am. Thank